Imaging of small bowel Crohn's disease: can abdominal CT replace barium radiography?

Abstract

Objectives: To analyze imaging features and compare the diagnostic information provided by abdominal computed tomography (CT) and enteroclysis to see whether CT can replace barium examinations in the assessment of patients with small bowel Crohn's disease. Methods: The abdominal CT studies and enteroclysis of 33 patients with small bowel Crohn's disease who underwent both examinations within a 2-week time period were retrospectively reviewed and scored for the presence and severity of the following features: mural edema, ulceration, small bowel obstruction, stricture, sinus tract formation, fistula, abscess, extraintestinal manifestations, and total number of intestinal sites involved. The statistical significance of the differences for each variable was calculated. Results: A total of 37 case sets were reviewed. CT demonstrated 10 (27 %) abscesses compared to 7 (19 %) shown by enteroclysis. Three extraintestinal sites shown by CT were not demonstrated by enteroclysis. Enteroclysis detected a larger number of intestinal sites of involvement (54 vs. 47) and more cases of ulceration (78 % vs. 19 %), small bowel obstruction (46 % vs. 16 %), stricture (38 % vs. 11 %), fistula formation (24 % vs. 8 %), and sinus tract formation (27 % vs. 5 %). The two modalities were similar in characterizing and grading the severity of mural thickening (CT showed 41 %, enteroclysis 46 %). Conclusion: Abdominal CT and enteroclysis provide unique and complementary diagnostic information in patients with Crohn's disease of the small bowel. Both methods may be required for the accurate assessment of the severity and extent of Crohn's disease of the small bowel. The choice of initial examination will depend on the clinical issue in question.